Jewish law is specific, and may appear inflexible; however, rabbinic interpretations and an improved understanding of modern medicine demonstrate that there is flexibility when approaching end-of-life care

Rabbinic involvement in medical decision making is common and may challenge conventional patient autonomy, particularly at the end of life where the threshold for withholding life sustaining treatments in view of ‘futility’ may be higher than western trained physicians. However, this is not universal and careful explanation of treatments and prognosis is vital in allowing the family to make decisions together with rabbis

Patients may request medical interventions which the medical team may be uncomfortable with, as the Halacha requires a physician to do everything in their power to prolong life, but prohibits actions which prolong the act of dying or hasten death

Healthcare professionals should explore and establish the importance of prayer needs, Shabbat observance and the degree of involvement of the rabbi and family in decision making

Jews refrain from actions considered work on the Shabbat, such as writing, carrying, use of electrical devices or business transactions. Be mindful of this when treating patients observing Shabbat, for example when prescribing patient-controlled analgesia (PCA)

A dying patient should not be left alone and Jews will wish to fulfil their obligation of ‘Biqqur Cholim’ (visiting the sick)

Judaism prohibits prayer in the presence of bodily fluids. The dying patient can be incontinent, so if the patient cannot be continually cleansed the family/clinical team should seek rabbinical guidance to determine the correct course of action